The present application relates generally to a catheter for use in transporting fluids, and particularly, to a catheter for transporting bodily fluids for extracorporeal treatment, and returning the treated fluids to the body.
Dual lumen catheters are commonly used for transporting bodily fluids for extracorporeal treatment. A fluid is withdrawn from the body through one of the lumens, generally referred to as the withdrawal lumen. The fluid is subjected to a treatment process, and thereafter returned to the body through the other lumen, generally referred to as the infusion lumen.
In many cases, the extracorporeal treatment involves a hemodialysis procedure. During hemodialysis, blood is withdrawn from a blood vessel through the withdrawal lumen and routed to a dialyzer for treatment. The cleansed blood is then returned to the vessel through the infusion lumen. When such a catheter is used for hemodialysis, it is generally inserted into the body through either the jugular vein, subclavian vein or femoral vein. In addition to hemodialysis, extracorporeal catheters can also be used for other procedures in which a fluid is removed from the body for treatment and later returned to the body. Two such examples are pheresis and hemofiltration.
A variety of hemodialysis catheters are commercially available. Among the types of commercially available catheters are: 1) a dual lumen catheter having one lumen (e.g., the blood infusion lumen), that terminates distal to the other lumen (e.g., the blood withdrawal lumen). Some catheters of this type are provided with a midline split (e.g., the Uldall catheter), while others do not have such a split (e.g., the COOK® DDS catheter); 2) a catheter having a slitted valve in the distal tip that acts as a pressure valve opening. This valve opens inwardly for blood aspiration, outwardly for blood infusion, and remains closed when not in use (e.g., the Groshong catheter); 3) various polyester cuffed central venous silicone catheters that are tunneled underneath the skin to reduce infection (e.g., Broviac, Leonard and Hickman catheters); 4) a dual lumen catheter having a tapered tip and two adjacent holes communicating with one lumen just proximal to the tip to assist with outflow, and two adjacent holes communicating with the other lumen (180 degrees removed) just proximal to the first set of holes to assist with inflow (e.g., the Mahurkar catheter); 5) a dual lumen catheter having a diverting structure consisting of a shoulder that has a straight up distal face and a sloped proximal face to reduce access recirculation and raise pressure in the vicinity of the inlet aperture (U.S. Pat. No. 6,409,700); and 6) a catheter designed for femoral approach having two sets of staggered side ports, resulting in a total of four side ports.
One problem with existing hemodialysis catheters is that such catheters can experience decreased flow rates over time. Decreased flow rates may be caused by, among other things, blockage of the withdrawal and/or infusion ports in the catheter. Various factors can cause a port to become blocked. One common cause of port blockage is the inadvertent positioning of one or more ports of the catheter against the vessel wall. This positioning hinders the free flow of fluid through the obstructed port, and in some cases, prevents fluid flow altogether. Another common cause of port blockage is the formation of fibrin sheaths along the ports. Such fibrin sheaths are normally formed in response to the vessel wall washing effect or clotting.
Decreased, or restricted, flow is clearly undesirable in an extracorporeal catheter, such as a hemodialysis catheter. In order for the extracorporeal fluid treatment to be effective, fluid flow through the catheter must not be restricted in any appreciable way. Thus, it is important to position existing catheters in a manner such that fluid flow is not restricted. Additionally, it is important to insure that all ports are unobstructed. Various attempts have been made to reduce port blockage. For example, as described above, some catheters are provided with side ports at various locations on the catheter. Side ports generally provide some reduction in port blockage, however such ports themselves are subject to blockage when placed against the vessel wall, or as a result of fibrin formation on the port. Other attempts have been made to reduce port blockage by providing the stepped side-by-side dual lumen design described above, wherein the respective withdrawal and infusion tubes are of different lengths so that the ports withdraw and infuse the bodily fluid at different axial locations of the catheter. While this arrangement may avoid some problems involved in maintaining adequate flow through the lumens, such catheters can still be subject to suboptimal flow. Some catheters, such as the Mahurkar catheter described above, must be rotated if inflow is blocked because the catheter is up against the vein wall. Although these techniques may be somewhat effective in reducing blockage, reduced flow rate continues to be a problem in the art.
It is desired to provide a multi-lumen catheter for use in the extracorporeal treatment of bodily fluids that minimizes port blockage, and that provides for optimal fluid flow through the lumens of the catheter.